National Institute for Health and Care Excellence

Lord McColl of Dulwich Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I know I have the answer here somewhere but I cannot find it, so I commit to write to the noble Baroness.

[Lord McColl of Dulwich (Con)]

My Lords, can the Minister kindly inform NICE and the Department of Health that they are misleading the nation and have done for years in telling them that all the calories we eat are used up in exercise? That is not true and has never been true. Only a fraction of the calories we eat are used up in exercise. Could the Minister do something about NICE and the Department of Health?

[Lord Kamall (Con)]

I will try my best. If I may, I shall use this opportunity to respond to the noble Baroness’s earlier question. We have seen horizon scanning in regulatory science, which means that ILAP is at the forefront of cutting-edge developments. It is open to commercial and non-commercial, and UK-based and global developers of medicines. As I said, I will write to the noble Baroness with more detail. On doing something about NICE and the NHS, I have constant meetings with the NHS, as do other Ministers. One of the challenges that came up during the passage of the Health and Care Bill—I know that noble Lords who have been Ministers previously made this point—was that Ministers here have to respond on issues but decisions are quite often taken at NHS level.

International Healthcare Outcomes

Lord McColl of Dulwich Excerpts

Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

When one looks at these reports, one sees that one area where the UK clearly needs to improve is on cancer. One of the great issues of this is diagnosis. As many noble Lords will know, when we look at the waiting lists and the backlog, we see that 80% of those people are waiting for diagnosis. It is essential that we tackle that. For children, the one-year survival rate has risen in recent years. We will continue to focus more on diagnosis, including community diagnosis centres.

[Lord McColl of Dulwich (Con)]

My Lords, in discussing the various factors involved, does the Minister agree that one of the main ones is that 71% of the British people are overweight or obese? Obesity impairs the immune system and leaves patients vulnerable to all kinds of illnesses which put an enormous burden on the NHS. Does he agree that the answer is for people to buy fewer calories and put fewer calories into their mouths?

[Lord Kamall (Con)]

The Government are doing a lot on the anti-obesity strategy in conjunction with the Office for Health Improvement and Disparities. We have brought together a number of issues. We have existing actions to halve childhood obesity by 2030 with new interventions. We have invested large amounts in weight management services. However, it is not only about reducing the calories taken in but about burning off those calories and getting the right balance between activity and consumption.

Health and Care Bill

Lord McColl of Dulwich Excerpts

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Baroness Whitaker (Lab)]

My Lords, I rise to support Amendments 30 and 34. On Amendment 30, I echo the widespread concern of the professional bodies and expressed by the noble Baroness, Lady Finlay, that rehabilitation should be a core service in the NHS. It is inseparable from healing, and healing is often impaired if rehabilitation is not there.

On Amendment 34, it will be important to know whether the proposed integrated health boards will be in contact with services outside the NHS where health can be a critical factor, such as education and criminal justice. As we said in Committee, many speech and language professionals are not NHS employees. How will they be brought into the integrated system?

[Lord McColl of Dulwich (Con)]

My Lords, I shall speak to Amendment 62 in my name and those of the noble Baronesses, Lady Hollins and Lady Walmsley, and the noble Lord, Lord Jones of Cheltenham. I thank them, and the Alzheimer’s Society and Alzheimer’s Research UK, for their support of this amendment.

People with dementia will be one of the largest groups of people to see the benefits of the integration of health and social care services and, therefore, the benefits from the Bill. Currently, there are 900,000 people living with dementia in the UK and, without a disease-modifying treatment available after diagnosis through the NHS, they get the majority of their support through the social care system.

This amendment relates to Clause 21, which ensures that integrated care partnerships prepare an integrated care strategy. These new strategies will be a powerful way to bring together various currently disparate bodies to work towards the same aims. Topics discussed within these strategies will be given consideration across the health and social care systems, consideration that too often people living with dementia have lacked, leaving them falling through the cracks between the various systems. This amendment therefore suggests that each strategy should explicitly consider the needs of people living with dementia. There are two areas where integration could provide particular benefits, which I will touch on briefly.

The first is diagnosis. A diagnosis is incredibly important for people living with dementia, as it allows them to plan for the future, arranging their housing and care needs, putting themselves forward for clinical trials and ensuring that they have first access to the most innovative treatments, while also unlocking access to vital extra support in the short term. This does not just help the individual. By providing the right support at the right time, we can reduce pressure on the NHS. That is why NHS England rightly has a target that two-thirds of all people living with dementia will have received a diagnosis. This was consistently met from 2015 until the pandemic. As people visited their GPs less frequently, clinicians were diverted to other areas and individuals had little access to memory clinics. The rate dramatically fell from 67.6% in January 2020 to just 61% in January 2022. This has meant that, according to NHS data, an extra 35,000 people are now living in the dark about their dementia status. As we address the backlogs in elective treatment and cancer care, it is vital that we also tackle the backlog in diagnosis of dementia. To do so, we must have clear strategies in place, at local and national level.

I am proud that the UK is seen as a world leader in dementia research, as many noble Lords know very well. However, there are still barriers to us reaching our potential, including a lack of participants for research. This is not because there is low interest in participating in research among the public. According to Alzheimer’s Research UK, 69% of the public would be willing to take part in dementia research. However, 81% did not know how to volunteer. The NHS, as a single health system, has many advantages which give it great potential for data sharing between research and clinical practice, connecting those who want to take part in studies with those conducting the studies.

A valuable report recently released by the All-Party Dementia Group, Fuelling the Moonshot, recommended that all newly diagnosed patients receive a letter from the NHS within three months of diagnosis, explaining how they can take part in dementia research. Integrating dementia research with integrated care partnerships will provide other benefits. The benefits should, and would, flow in both directions. While research can benefit from better access to participants, it should also ensure that innovation, whether in treatments or models of care, can reach people living with dementia.

Sugar

Lord McColl of Dulwich Excerpts

Monday 24th January 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for raising the success so far of the programme in reducing sugar in drinks. Between 2015 and 2019, we saw a 44% reduction in sales-weighted average total sugar in retailer and manufacturer-branded drinks subject to the soft drinks industry levy. The money raised through the soft drinks industry levy was not linked to any specific programmes or departmental spending. As the noble Baroness will be aware, departmental spend is allocated through spending reviews by the Treasury, and there is quite often some scepticism over hypothec—sorry, probably too much sugar, or not enough sugar—or hypothecated taxes, but we are committed to tackling childhood obesity through a number of different programmes.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that the problem is not just sugar but the fact that people are putting too many calories of all sorts in their mouth? The real answer to the obesity epidemic and the Covid problem is to reduce the total number of calories going into the mouth. If your waist measurement is more than half your height, you are eating too much of the gross national product.

[Lord Kamall (Con)]

I thank my noble friend for that catchy slogan; I wonder whether we could use it in some of our campaigns. As he rightly says, it is not just sugar. There are concerns about ultra-processed foods, for example, but also the size of portions. Many noble Lords will be aware that, for some simple products, the portion sizes have increased over the years, and if you want to get a small portion you have to either buy something and share it with someone or throw away half of it. We are looking at all these measures to make sure that our diets are healthier, that we have the right balance with smaller portions and that people are doing exercise. It is one thing is to consume those calories but another to burn them off.

Eating Disorders

Lord McColl of Dulwich Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for raising the issue of the backlog as a result of the pandemic. We have seen eating disorder services continue to face increasing demand, especially as a result of lockdown and its mental health impact. The number of young people entering urgent treatment has increased by 73% between 2019-20 and 2021, and the numbers waiting for treatment have also increased from 561 to 2,083. To make sure that we meet the standard and get those waiting times down, we have invested an extra £79 million this financial year, and we are working with systems across the country to see how we can make sure that we address young people and adults who need access to this treatment.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that it is a very serious condition that 71% of the British people over the age of 30 are obese or overweight? The problem with this is that it interferes with the immune system, which makes them much more vulnerable to all kinds of diseases, not least infections. If we want to deal with the next pandemic now, we have to get people to reduce their weight so that obesity does not interfere with their immune systems.

[Lord Kamall (Con)]

The question from my noble friend highlights the difficulty of dealing with such a sensitive area. You have to be very careful how you address the issue of obesity. For example, it is quite right that we want to get the rates of obesity down, because it does lead to a number of other conditions that we have discussed many times here. One thing that you have to look at, however, is the unintended consequence of any laws. One possible unintended consequence is that some of the measures to tackle obesity, such as looking at food labelling, might affect people who have eating disorders. Every time we look at the obesity strategy, therefore, we make sure that we consult charities that look after people with eating disorders to ensure that we have the right balance. We will not always get it perfectly right, but we will try our best.

COVID-19: Type 2 Diabetes

Lord McColl of Dulwich Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

The Government and the Department of Health and Social Care are reviewing the many impacts of Covid-19 that noble Lords will acknowledge. We are still trying to understand the various implications of lockdown. We have seen increases in weight leading to more type 2 diabetes. I will write to the noble Lord giving a detailed answer to his question.

[Lord McColl of Dulwich (Con)]

My Lords, as my noble friend Lady Jenkin has already mentioned, we have known for many years that reducing weight can reverse type 2 diabetes. With others, I was doing this successfully over 60 years ago. This draws attention to the urgent need for an even greater campaign to deal with the 71% of people in the UK over the age of 30 who are obese or overweight.

[Lord Kamall (Con)]

The Government have implemented weight-management services. Tier 2 behavioural weight-management services have been provided by 98% of local authorities thanks to the distribution of £30.5 million as part of the adult weight-management services grant. Additionally, £12.8 million was invested in an NHS digital weight-management programme for individuals with multiple long-term conditions, as well as NHS staff. There are a number of other programmes related to weight management which I may well go into in answering a later question.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord McColl of Dulwich Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord McColl of Dulwich (Con)]

My Lords, I have been given permission to sit while giving my speech because I am having great difficulty with my vision. First, I thank the noble Lord, Lord Patel, for initiating this discussion on the report on ageing. The report makes the apt point that, although life expectancy is increasing,

“the UK has seen low rates of life expectancy increases compared with most European and other high-income countries.”

With any medical condition, we must focus first on diagnosis, secondly on aetiology and, thirdly, on treatment. Well, the diagnosis is clear: the people of the UK are the most unhealthy in Europe. Seventy one per cent of those aged over 30 are obese or overweight. When I first mentioned that statistic last year in the Chamber, it was dismissed by a prominent politician as being over the top. I was not over the top; I was just dealing with facts, truth and science.

As the noble Baroness, Lady Sheehan, mentioned, obesity leads to widespread disease, including type 2 diabetes, hypertension, strokes, heart attacks, dementia and many other conditions that cause premature ageing, morbidity and death. The fat in the gross excess of fat cells leaks out, impairs the immune system and leaves the polluted body susceptible to very many diseases, especially infections such as Covid-19. The countries with the highest prevalence of obesity are the ones with the greatest incidence of Covid-19. So when the Prime Minister was accused of being responsible for 130,000 deaths, it was a false accusation. The aetiology of obesity epidemics is simply that people are putting too many calories into their mouths. Therefore, the treatment is, first and foremost, to get obese people to put fewer calories into their mouths. In fact, the Prime Minister was the first national leader to advocate eating less in order to reduce the obesity epidemic. He showed the way by losing three stone himself and coined the phrase, “Don’t be fatty at 50”.

Before we focus on complex solutions, we must first ensure that we have mastered the simple ones. It is not the case that eating less is impossible; what is impossible is to go on eating too much and remain healthy. There is no doubt that eating less requires effort and, for some, it is very difficult indeed, but the effort pays off in terms of morbidity, mortality and improving the quality of life in old age.

It was said that one group of people suffered more from Covid because of poverty and government cuts. Then an honest commentator pointed out that this particular group of people is more likely to suffer from heart attacks, strokes, type 2 diabetes and hypertension, but no one had the courage to say that the cause of those four conditions was mainly obesity. The critics say that they were obese because they could not afford the right food, but they would not be obese if they ate less of the wrong food.

Elements of the scientific world and some authorities have confused the public by mixed and inaccurate messages—for instance, that physical exercise is the answer to the obesity epidemic. The scientific institution known as NICE has maintained for years that all the calories we eat are used up on exercise, but surely one of the 500 employees of NICE could have gone to the gym, exercised for half an hour on a machine and seen how few calories they expended. On average, approximate intake of adults is 2,000 to 2,500 calories a day, which means that a person would have to exercise for four or five hours every day to burn up the calories they ate. This would increase their appetite and their calorie intake. I should emphasise that physical activity is essential for good health but is not an effective way of reducing weight.

There should be a clear message to the public that obesity is a disease that destroys the human body slowly and, as people get older, produces an enormous amount of suffering and death. The Department of Health has not always been helpful, in that it advocated a low-fat diet—but it is fat that acts as a brake, limiting the amount we eat. We clearly need to limit the amount of saturated fat, but unsaturated fat is fine. As fat leaves the stomach it goes into the duodenum and releases hormones that act on the stomach, delaying its emptying, thus giving an early sensation of fullness and satiety. After the fat has been emulsified and absorbed, it moves down the small intestine and normal service is resumed by the stomach. This is a beautiful mechanism that limits the amount we eat but, not surprisingly, the food industry dislikes it.

In the 1970s, Professor John Yudkin of London University set out clearly in his research that fat was not the problem; the problem lay in sugar. The food industry not only deliberately demonised fat but demonised Professor Yudkin. It was influential in his dismissal from his university post. The food industry advocated a low-fat diet, which is not only tasteless but bad for sales. It therefore added large quantities of sugar to the diet, and so the rot set in, with increasing obesity leading to the obesity epidemic.

Whole milk used to play an important part in limiting how many calories people ate. Skimmed milk was an industrial by-product which was at first discarded, then fed to animals and later to humans. The Department of Health has not helped matters by continuing to advocate a low-fat diet. It told GPs not to call patients obese because it was judgmental; it does not seem to realise there is a distinct difference between being judgmental and making accurate diagnoses.

The committee’s report focuses on the cure for the lifestyle choices of an ageing population, but prevention is better than cure. We could save millions from untimely deaths and billions in expenses if we focused on prevention. The struggle to keep an ageing population healthy has no greater challenge than this: the problems posed by bad choices. What is the Government’s role? It is not to tell people what to do. Instead, it is to honestly present them with the facts and the truth, and encourage them to make the right choices to grow older unhindered by increasing morbidity and mortality.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Lord McColl of Dulwich Excerpts

Thursday 22nd July 2021 Lords Chamber

[Lord McColl of Dulwich (Con) [V]]

My Lords, my noble friend Lady Jenkin has already mentioned that for many years in this House we have been calling for action to deal with the obesity epidemic, mainly with the slogan, “The obesity epidemic is killing millions, costing billions and the cure is to put fewer calories into their mouths”. This will save a great deal of money and reduce the strain on the NHS, as has already been mentioned.

It will probably come as no surprise to noble Lords that I support these draft calorie labelling regulations. There are a few problems, which I think can be ironed out quite easily. First, fat, preferably unsaturated fat, acts as an important brake on how much we eat, as does whole milk. This was demonstrated by scientists in Canada and, recently, Danish scientists showed that whole milk actually reduced the level of cholesterol in the blood. We need to remind ourselves that fat produces twice as many calories as protein and carbohydrate, so this needs to be taken into account in calorie labelling and working out what to buy and eat.

These regulations, as has been mentioned, can present problems for those with eating disorders. I hope that it will help them to have menus available that have no mention of calories at all, and I hope that it will be essential for restaurants to have those menus available.

On average, 2,000 calories per day is mentioned, but of course the total number of calories one should eat will vary substantially from person to person, according to occupation, age and weight. It is worth reminding ourselves that the all-powerful food lobby was the culprit in causing this obesity epidemic in the first place. It wanted to get people to eat more food but realised that it was the fat they were eating that slowed the stomach emptying and made them feel full and satisfied early on in the meal. So the lobby demonised fat and insisted on a low-fat diet, which is so tasteless that it then had to add a great deal of sugar to make its manipulated food palatable. It pilloried those who opposed it, including Professor John Yudkin, who was sacked from his university chair of nutrition in London for warning against the high-sugar, low-fat diet. So much for the so-called independence of universities. We need to counter the anti-people’s lobby, which wants to stop people from having whole milk and healthy fat because these villains know that fat reduces appetite and reduces their ill-gotten gains.

It was gratifying to see reference at the end of the document warning against the potentially fatal combination of Covid and obesity. People should take note of that, especially in both Houses of Parliament—that obesity is one of the problems causing high mortality from Covid. I wish more people would join the Prime Minister’s campaign to tackle the obesity epidemic with his slogan, “Don’t be a fatty in your fifties”.

Covid-19: Aligning UK and Foreign Entry and Return Requirements

Lord McColl of Dulwich Excerpts

Monday 19th July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

[Inaudible]—are engaging with a range of international partners, including the EU and the US, on mutual recognition. Ministers have agreed to begin the formal process of reaching a technical agreement with the EU on mutual recognition of vaccine certificates. This would allow the digital verification of vaccine certificates between the UK and the EU. We believe that this process could be complete within a month, pending the Commission’s acceptance of our application.

[Lord McColl of Dulwich (Con) [V]]

My Lords, have the discussions with these countries involved the question of herd immunity, bearing in mind that countries with low levels of vaccination which have closed their borders will have fewer Covid infections? That could result in less herd immunity in the long term in countries such as New Zealand and Australia, which have closed their borders.

Organ Tourism and Cadavers on Display Bill [HL]

Lord McColl of Dulwich Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Lord McColl of Dulwich (Con) [V]]

My Lords, I also thank the noble Lord, Lord Hunt, for presenting this valuable Bill. Of all the different operations that I used to do, kidney transplantation was the most exciting. When the vein and artery were connected to the donor kidney, it would spring to life. As a contribution to good Anglo-French relations, I pay tribute to France: the French kidneys were the best of all because they would start functioning immediately by peeing on the operating table. The reason for this was said to be French wine being a good diuretic. As there was always a shortage of kidneys, there was a European system for sharing in order to have the best match for each patient. Unfortunately, this shortage led to abuses of all kinds. On many occasions, live donors were paid to give their kidneys, for a relative or a stranger. It later transpired that genuine consent was often not obtained.

Later, the horror of the Chinese practice of forcibly taking kidneys from prisoners came to light. The numbers involved have shocked the world, but is the world going to repeat its failure to take action against the Nazi atrocities, which also included horrific medical experiments on prisoners? Instead of an effective response to China, the West continues to allow it to buy up our industries, enabling the Chinese Government’s plan to dominate and control the world. When will the world wake up and take effective action?

On medical devices, it is worth saying that the medical profession has a history of reluctance to put foreign materials into bodies. The surgeon who pioneered the use of metal plates and screws to fix fractures was threatened with removal from the medical register. Another example was an eye surgeon, Harold Ridley, who was carrying out a standard operation for cataracts in 1949, simply removing the cataract and sewing up the eye. A medical student who was watching the operation suggested that perhaps the cataract should be replaced with an artificial lens. What the surgeon said at the time was not recorded, but he kept the suggestion in his mind and, the following week, he noticed a piece of plastic from a smashed windscreen in a pilot’s eye—but there had been no reaction to it. So began artificial lens implantation. In spite of great opposition, it was finally accepted 25 years later. New inventions are often opposed. Careful evaluation is essential to allow and promote good new developments as well as to stop harmful ones.